GI and Liver Flashcards
how can you differentiate biliary colic from acute cholangitis
In contrast to acute cholecystitis, there is no fever and inflammatory markers are normal in biliary colic
what is charcot’s triad
- it is
- right upper quadrant pain
- fever
- jaundice
- it’s for ascending cholangiti
- it occurs in ~20-50% of people with ascending cholangitis
is pain from duodenal ulcers or gastric ulcers made worse by eating
Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating
Gastric ulcers: epigastric pain worsened by eating
what is rovsing’s sign?
more pain in RIF than LIF when palpating LIF
it indicates appendicitis
when would you get tinkling bowel sounds
if there is intestinal obstruction
how does the pain differ between renal colic and acute pyelonephritis
- renal colic:
- Pain is often severe but intermittent. Patient’s are characteristically restless
- Visible or non-visible haematuria may be present
- acute pyelonephritis:
- Fever, vomiting and rigors
what is the most common causative organism in ascending cholangitis
E. coli
what is reynold’s pentad for ascending cholangitis
- it’s charcot’s triad:
- fever
- RUQ pain
- jaundice
- plus hypotension and confusion
it’s for ascending cholangitis
how do you diagnose ascending cholangitis
ultrasound is generally used first-line in suspected cases to look for bile duct dilation and bile duct stones
bloods will show raised white cells and raised inflammatory markers
what is the management of ascending cholangitis
intravenous antibiotics
endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction
clincal features of acute pancreatitis
severe epigastric pain that may radiate through to the back
vomiting is common
examination may reveal epigastric tenderness, ileus and low-grade fever
periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
how do you diagnose pancreatitis
a diagnosis of acute pancreatits can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level
however, early ultrasound imaging is important to assess the aetiology as this may affect management - e.g. patients with gallstones/biliary obstruction
what are the two important blood tests for pancreatitis
- serum amylase
- raised in 75% of patients
- typically > 3 times the upper limit of normal in pancreatitis
- levels do not correlate with disease severity
- specificity about 90%
- serum lipase
- more sensitive and specific than serum amylase
what are the non-pancreatitis causes of raised amylase
pancreatic pseudocyst
mesenteric infarct
perforated viscus
acute cholecystitis
diabetic ketoacidosis
what are some poor prognostic factors in pancreatitis
- age > 55 years
- hypocalcaemia
- hyperglycaemia
- hypoxia
- neutrophilia
- elevated LDH and AST
what are the causes of pancreatitis
- GETSMASHED
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps (other viruses include Coxsackie B)
- Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
- Scorpion venom
- Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
- ERCP
- Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
how do you classify the severity of pancreatitis

management of pancreatitis
- fluids
- aggressive early rehydration with crystalloids
- aim for urine output of 0.5ml/kg/hr
- may relieve pain by treating lactic acidosis
- analgesia
- IV opioids
- nutrition
- don’t make them nil by mouth unless they are vomiting
- enteral nutrition should be offered to anyone with moderately severe or severe acute pancreatitis within 72 hours of presentation
- parenteral nutrition only used if enteral fails
- surgery
- if due to gallstones then cholecystectomy
- if obstructed biliary system due to stones then ERCP
- if infected necrosis then either radiological drainage or surgical necrosectomy.
what is the main cause of chronic pancreatitis
- 80% of cases are due to excess alcohol use
- 20% of cases are due to:
- genetic: cystic fibrosis, haemochromatosis
- ductal obstruction: tumours, stones,
clinical features of chronic pancreatitis
- pain is typically worse 15 to 30 minutes following a meal
- steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
- diabetes mellitus develops in the majority of patients typically more than 20 years after symptom begin
how do you investigate chronic pancreatitis
- CT shows pancreatic calcification
- faecal elastase detects pancreatic exocrine function
management of chronic pancreatitis
pancreatic enzyme supplementation
analgesia
is there a vaccine for hepatitis C
no
what is the investigation to diagnose hepatitis C
HCV RNA